المؤلفون: Veldhuis, Lars I.^{Aff1, Aff2, IDs12873024010417_cor1}, Gouma, P., Nanayakkara, Prabath W. B., Ludikhuize, J.^{Aff3, Aff4}

المصدر: BMC Emergency Medicine. 24(1)

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.

المؤلفون: Smit, J.M., Krijthe, J.H., Tintu, A.N., Endeman, H., Ludikhuize, J., Genderen, M.E. van, Hassan, S., Moussaoui, R. el, Westerweel, P.E., Goekoop, R.J., Waverijn, G., Verheijen, T., Hollander, J.G. den, Boer, M.G.J. de, Gommers, D.A.M.P.J., Vlies, R. van der, Schellings, M., Carels, R.A., Nieuwkoop, C. van, Arbous, S.M., Bommel, J. van, Knevel, R., Rijke, Y.B. de, Reinders, M.J.T.

المساهمون: Intensive Care, Clinical Chemistry

المصدر: Intensive Care Medicine Experimental, 10(1):38. Springer Open
Intensive Care Medicine Experimental, 10(1). SPRINGER
Intensive Care Medicine Experimental, 10(1)

مصطلحات موضوعية: Artificial intelligence, Intensive care, Machine learning, COVID-19, Early warning score, Dynamic model updating, Critical Care and Intensive Care Medicine, Medical prediction model

الوصف: Background Timely identification of deteriorating COVID-19 patients is needed to guide changes in clinical management and admission to intensive care units (ICUs). There is significant concern that widely used Early warning scores (EWSs) underestimate illness severity in COVID-19 patients and therefore, we developed an early warning model specifically for COVID-19 patients. Methods We retrospectively collected electronic medical record data to extract predictors and used these to fit a random forest model. To simulate the situation in which the model would have been developed after the first and implemented during the second COVID-19 ‘wave’ in the Netherlands, we performed a temporal validation by splitting all included patients into groups admitted before and after August 1, 2020. Furthermore, we propose a method for dynamic model updating to retain model performance over time. We evaluated model discrimination and calibration, performed a decision curve analysis, and quantified the importance of predictors using SHapley Additive exPlanations values. Results We included 3514 COVID-19 patient admissions from six Dutch hospitals between February 2020 and May 2021, and included a total of 18 predictors for model fitting. The model showed a higher discriminative performance in terms of partial area under the receiver operating characteristic curve (0.82 [0.80–0.84]) compared to the National early warning score (0.72 [0.69–0.74]) and the Modified early warning score (0.67 [0.65–0.69]), a greater net benefit over a range of clinically relevant model thresholds, and relatively good calibration (intercept = 0.03 [− 0.09 to 0.14], slope = 0.79 [0.73–0.86]). Conclusions This study shows the potential benefit of moving from early warning models for the general inpatient population to models for specific patient groups. Further (independent) validation of the model is needed.

وصف الملف: application/pdf

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d2f715f5e014ff1c59a5e97ae1f324ba
http://resolver.tudelft.nl/uuid:8ff92af8-b412-4f21-b800-0a180a630144

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.

المؤلفون: Ludikhuize, J., Dijkgraaf, M. G., Dave Dongelmans, So, R., Korsten, E., Schoonderbeek, J., Kors, B., Vermeijden, W., Tangkau, P., Tjan, D., Jones, D. A., Kalkmanm, C.

المساهمون: Epidemiology and Data Science, APH - Methodology, Intensive Care Medicine, AII - Infectious diseases, APH - Quality of Care

المصدر: Netherlands journal of critical care, 29(3), 140-147. Netherlands Society of Intensive Care
Web of Science

مصطلحات موضوعية: nursing ratios, rapid response system, escalation of care, modified early warning score, deteriorating patient, vital signs

الوصف: Background: Rapid response systems (RRSs) have been introduced to assist in the effective management of deteriorating patients. Optimal system performance requires adequate staffing levels and compliance with the escalation protocol. Delay and failures in activation of the rapid response team (RRT) are directly correlated to adverse outcomes. The current study analyses clinical practice and adherence to the RRS protocol in the Netherlands in correlation with demographic data from the hospitals. Methods: A multicentre cross-sectional survey using a vignette-based questionnaire was employed. Healthcare providers on the included medical and surgical wards participated. A descriptive analysis was performed on the data from the questionnaires and correlated to RRT activations and nurse-to-patient ratios. Results: The response rate was 31% (n=654). During the day shift, a ratio of 5-8:1 (patient-to-nurse) was reported in 52-60% of the hospitals. During evening shifts, 20-34% reported ratios of more than 8:1, and overnight, at least 84% reported even higher ratios. More than 50% of nurses perceived their workload to be ‘fairly heavy’. In contrast, 55-66% of the registrars perceived their workload to be ‘fairly heavy’ whereas consultants deemed work to be balanced. Upon detection of a deteriorating patient, nurses called the doctor in 88-90% of cases. The RTT was activated in 90% of cases. Conclusion: Compliance with RRS processes is reported to be high. Nurses reported significant workloads and high patient-to-nurse ratios. These ratios are likely to affect the ability to escalate care and provide optimal management for the deteriorating patient.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=dedup_wf_001::00275588daf1b68142090ec2d6801956
https://pure.amc.nl/en/publications/clinical-practices-in-the-escalation-of-care-for-the-deteriorating-patient(43d2e7af-82a9-4494-baaf-b642cf2a1ef7).html

لا يتم عرض هذه النتيجة على الضيوف.
تسجيل الدخول للوصول الكامل.

المؤلفون: Ludikhuize, J., Brunsveld-Reinders, A.H., Dijkgraaf, M.G.W., Smorenburg, S.M., Rooij, S.E.J.A. de, Adams, R., Maaijer, P.F. de, Fikkers, B.G., Tangkau, P., Jonge, E. de, Cost Outcomes Med Emergency Teams

المساهمون: AII - Amsterdam institute for Infection and Immunity, ANS - Amsterdam Neuroscience, Other Research, Anesthesiology, Clinical Research Unit, Other departments, Geriatrics, Nursing, Patient Care Support

المصدر: None
Critical Care Medicine, 43(12), 2544-2551
Critical care medicine, 43(12), 2544-2551. Lippincott Williams and Wilkins
Critical Care Medicine, 43, 12, pp. 2544-2551
Critical Care Medicine, 43, 2544-2551

مصطلحات موضوعية: Male, medicine.medical_specialty, Cost-Benefit Analysis, deteriorating patients, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, multicenter trial, Randomized controlled trial, law, Multicenter trial, Outcome Assessment, Health Care, Patients' Rooms, Severity of illness, medicine, Humans, Hospital Mortality, Prospective Studies, rapid response team, Prospective cohort study, Rapid response team, Netherlands, business.industry, adult, Other Research Radboud Institute for Health Sciences [Radboudumc 0], rapid response system, Odds ratio, Early warning score, Heart Arrest, Intensive Care Units, Emergency medicine, Modified Early Warning System, Female, business, Rapid response system, Hospital Rapid Response Team

الوصف: Objective: To describe the effect of implementation of a Rapid Response System (RRS) on the composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death. Design: Pragmatic prospective Dutch multi-center before-after trial, Cost and Outcomes analysis of Medical Emergency Teams (COMET) trial. Setting: Twelve hospitals participated, each including two surgical and two non-surgical wards between April 2009 and November 2011. The Modified Early Warning Score (MEWS) and Situation-Background-Assessment-Recommendation (SBAR) instruments were implemented over seven months. The Rapid Response Team (RRT) was then implemented during the following 17 months. The effects of implementing the RRT were measured in the last 5 months of this period. Patients: All patients 18 years and older admitted to the study wards were included. Measurements and main results: In total 166,569 patients were included in the study representing 1,031,172 hospital admission days. No differences were observed in patient demographics between periods. The composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death per 1000 admissions was significantly reduced in the RRT versus the before phase, adjusted odds ratio (OR) 0.847 (95% CI 0.725-0.989, p=0.036). Cardiopulmonary arrests and in hospital mortality were also significantly reduced, OR 0.607 (95 CI 0.393-0.937, p=0.018) and OR 0.802 (95% CI 0.644-1.0, p=0.05) respectively. Unplanned ICU admissions showed a declining trend, OR 0.878 (95% CI 0.755-1.021, p=0.092) whereas severity of illness at the moment of ICU admission was not different between periods. Conclusions: In this study, introduction of nationwide implementation of RRSs was associated with a decrease in the composite endpoint of cardiopulmonary arrests, unplanned ICU admissions and mortality in patients on general hospital wards. These findings support the implementation of RRSs in hospitals to reduce severe adverse events.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dad75607d82dd01fd78733b085f2bf46
https://doi.org/10.1097/ccm.0000000000001272

المؤلفون: Brunsveld-Reinders, A.H., Ludikhuize, J., Dijkgraaf, M.G.W., Arbous, M.S., Jonge, E. de, COMET Study Grp

المساهمون: Patient Care Support, Anesthesiology, Clinical Research Unit, Other departments

المصدر: Critical Care
Critical care (London, England), 20(1). Springer Science + Business Media
Critical Care, 20

مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Hospitalized patients, Cost-Benefit Analysis, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Patient safety, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Intensive care medicine, Rapid response team, Limitations of medical treatment, Aged, Randomized Controlled Trials as Topic, Aged, 80 and over, business.industry, Research, Medical record, Communication, 030208 emergency & critical care medicine, Unexpected death, Intensive Care Units, Editorial, Emergency medicine, Time course, Female, General ward, business, Medical Futility, All cause mortality, Rapid response system, Hospital Rapid Response Team

الوصف: Background The purpose of this study was to assess the effect of replacing all-cause mortality by death without limitation of medical treatments (LOMT) as the endpoint in a study of rapid response teams (RRTs) in hospitalized patients. We also described the time course of LOMT orders in patients dying on a general ward and the influence of RRTs on such orders. Methods This study is a secondary analysis of the COMET trial, a pragmatic prospective Dutch multicenter before-after study. We repeated the original analysis of the influence of RRTs on death before hospital discharge by replacing all-cause mortality by death without an LOMT order. In a subgroup of all patients dying before hospital discharge, we documented patient demographics, admission characteristics and LOMT orders of each patient. Patients age 18 years or above were included. Results In total, 166,569 patients were included in the study. The unadjusted ORs were 0.865 (95 % CI 0.77-0.98) in the original analysis using all-cause mortality and 0.557 (95 % CI 0.40-0.78) when choosing death without LOMT as the endpoint. In total, 3408 patients died before discharge. At time of death, 2910 (85 %) had an LOMT order. Median time from last change in LOMT status and death was 2 days (IQR 1–5) in the before-phase and median time after introduction of the RRT was 1 day (IQR 1–4) (p value not significant). Conclusions The improvement in survival of hospitalized patients after introduction of a rapid response team in the COMET study was more pronounced when choosing death without limitation of medical treatment, rather than all deaths as the endpoint. Most patients who died during hospitalization had limitation of medical treatments ordered, often shortly before death. Rapid response teams did not influence the institution of limitation of medical treatments.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::921fe969d11accc860c8fc755dbf5870
https://pubmed.ncbi.nlm.nih.gov/27538514